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Loose skin dangles around Mohammad Zakrullah's angular pelvis and emaciated thighs when he squirms in famished discomfort. His newborn forehead and scalp glow ghostly purple, from the permanganate solution his mother, Chori Khul, has smeared on them, believing it would ward off hunger headaches. Next to his blue blanket, a rusted bukhari stove of soldered iron burns sharp coils of dry desert grass and donkey dung, and belches out more smoke than heat.

What can Chori Khul do for her son, 40 days old and already wasted, other than swaddle him in a hand-me-down shirt festooned with coins and two quilt coats that her other five children wore when they were infants? She squats by Mohammad Zakrullah, reaches inside her blue-and-white dress, and pulls out her right breast. Barren. No milk at all. Sucked dry by the gruel of life in the desert, by days of dividing up pittances of rice for breakfast, lunch, and dinner among her family of eight, who share the single room in a house raised with mud.

In Oqa, Chori Khul's village of some 40 low houses that gape doorless at the endless desert of northern Balkh province, few have heard of the billions of dollars of international aid that has poured into Afghanistan in the decade since the U.S.-led invasion. Just as well. The money has made little difference in the lives of Afghanistan's children, who continue to die at the second-highest rate in the world: Fourteen every half hour, largely from preventable causes such as acute malnutrition, of which Afghanistan has one of the highest rates in the world. Health care officials in Balkh province—population 2 million—estimate that levels of acute malnutrition among the children here range between 7 and 10 percent. This means that as many as 40,000 children in Balkh, mostly infants and toddlers, are teetering, like Mohammad Zakrullah, between life in destitution and death from hunger.

The causes of malnutrition here are prevalent: Drinking water festering with diseases that cause rapid dehydration through diarrhea; and mothers who are half-starved themselves on a diet of rice, bread, and tea, and exhausted from having too many babies one after the other. Yet the Afghan health ministry operates only 20 beds for acutely malnourished children in Balkh, and they are all at the same congested, fetid hospital in Mazar-e-Sharif, the provincial capital. The hospital treats about 400 and 450 children for acute malnutrition each year.

The international relief agency Save the Children operates an additional program to combat acute malnutrition; since it started last July, it has treated 337 children under the age of five in Balkh. Doctors and nurses at the province's 86 government hospitals and clinics are also trained by the ministry of healthto teach new mothers how to properly nurse and feed their children. "Of course, if they don't come to the hospital to deliver babies, they don't learn this information," says Dr. M. Saber Nadiri, head of the health ministry's office in Balkh. Most women in the province, he adds, give birth at home.

"We have clinics in all the villages," Dr. Nadiri insists. Then, he corrects himself: "If there isn't a clinic, then you walk for a kilometer or two, and there's a clinic." But the nearest clinic to Oqa is three hours by foot in the small desert town of Zadyan. And the nearest hospital where Mohammad Zakrullah might be able to receive the protein-rich therapeutic feed that would secure his recovery is in Dawlatabad, a city that's a day's donkey ride west of Oqa. Coincidentally, Chori Khul's husband spends most of his time in Dawlatabad, where he hires himself out as a well digger, a day laborer. He comes home every two or three days, carrying oil and rice, which he buys with his entire paycheck. But he cannot take the baby to the hospital, Chori Khul explains: "He has no money to pay the doctor—if the rest of us want to eat."

A few women, Chori Khul's neighbors, cram into the room to nod at little Mohammed Zakrullah in a kind of unsurprised resignation. The room smells of urine, dust, manure, and straw. It smells of the acrid smoke from the bukhari and of the opium smoked here—a traditional pastime in this part of Afghanistan, where the narcotic is smoked and drunk with tea as a cure for hunger, the common cold, muscle aches, stomach cramps, and woe. I ask the women if they have seen babies this malnourished in Oqa before.

Oh, yes, yes, they nod. All our babies look like that.

How much weight has Mohammad Zakrullah lost since he was born? His mother shrugs. No one in Oqa owns a scale.

Even if Mohammad Zakrullah pulls through, a centuries-old lifestyle and modern wartime laws already have scripted his life in this village. As a boy, he will collect tumbleweed under an agonizing sun for sale as firewood in Zadyan. As a man, he will draw murky water by rope out of an open well 75 feet deep. He will never have enough to eat, and his wife will grow old by her second child. He will smoke opium to take his mind off his hardship. But current statistics suggest that his hardship will not last very long: Despite international promises of aid and prosperity, the average life expectancy of Afghan men and women remains 44 years.